2022/2023 Product Program Caregiver Responsibility Agreement

Thank you for supporting your Girl Scout participating in Girl Scouts of Northern California’s (GSNorCal) entrepreneurship development product programs—the Fall and Cookie Program. Submission of this form provides permission to participate for the 2022/23 program year.

Only one submission is required for your Girl Scout to participate in both the Fall and Cookie Program.

CAREGIVER RESPONSIBILITY AGREEMENT

By signing below, I understand and agree to the following:

My Girl Scout is a registered member of GSNorCal for the 2022/23 membership year.
My Girl Scout has permission to voluntarily participate in the GSNorCal Product Programs.
My Girl Scout and I will model commitment to the Girl Scout Promise, Law, and philosophy at all times.
I accept personal financial responsibility for all products and money my Girl Scout receives and agree that GSNorCal reserves the right to take appropriate collection action to secure payment.
I will request and retain a receipt each time product is received and money is turned in to my troop.
I agree that only Girl Scouts sell Girl Scout products. Family members, friends, and businesses may not sell Girl Scout products.
My Girl Scout will not sell to the public prior to published program dates.
My Girl Scout will sell products at the retail prices set by GSNorCal.
My Girl Scout will have adult guidance at all times when participating in the programs, in-person and online, and follow all safety guidelines.
All donations accepted during each program’s dates will be applied toward the program’s Care to Share service project per IRS regulations.
I will ensure that 100% of the revenue collected for products my Girl Scout receives is submitted to the troop by the program due date(s) or GSNorCal will add an additional $35 processing fee to the balance.
I will ensure my Girl Scout shares her reward choices by the program’s due date(s) and agree that choices not indicated by this date will default to the Reward Card at that level.
I understand my Girl Scout's reward choices will be delayed until her balance for product programs is paid in full.

Caregiver/Girl Information and Agreement

Girl Scouts Name: *

Caregiver Name: *

Girl Scout Date of Birth * +

Caregiver Signature: *

Email: *

Phone #: *

Troop Leader Email: *

Troop #: *

Date: * +

Electronic Signature

Electronic Signature By typing my name on this form, I am entering my "electronic signature" (as defined in The California Uniform Electronic Transactions Act 1633.1 - 1633.17) and certifying that I have read, fully understand and accept all terms of this agreement.

Please type your full name here: *

Published 07/29/2022

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.